Private Health Insurance Act 2007
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Hide history noteA private health insurer may claim reimbursement from the Chief Executive Medicare in accordance with section 279-10 for each month during which it is a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
participating insurer.[
CCH Note:
S 279-1 will be substituted by No 54 of 2025, s 3 and Sch 2 item 10, effective 4 May 2026 or a single day to be fixed by Proclamation. However, if the provisions do not commence within the period of 6 months beginning on the day this Act receives the Royal Assent, they commence on the day after the end of that period. S 279-1 will read:
SECTION 279-1 WHO CAN MAKE REIMBURSEMENT CLAIMS
279-1(1)
A private health insurer may claim reimbursement from the Chief Executive Medicare for amounts by which premiums under a
*
complying health insurance policy issued by the private health insurer are reduced because of the operation of Division
23
if:
(a)
the private health insurer is a
*
participating insurer when the premium is reduced; and
(b)
the premium is reduced in the 36 month period ending before the month in which the claim for reimbursement is made.
279-1(2)
The claim for reimbursement must be made in accordance with section
279-10
.
No 54 of 2025, s 3 and Sch 2 items 25
-
35 contain the following application, transitional and validation provisions:
Act
amending Part
commencement time
the registration of the person is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person was registered: the refusal to register the person is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person was refused registration: the revocation of the person
'
s registration is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person
'
s registration was revoked:
25 Definitions
]
25
In this Part:
means the
Private Health Insurance Act 2007
.
means Part 1 of this Schedule.
means the commencement of this Schedule.
(1)
Subsections
23-15(2)
and
(3)
of the Act, as amended by the amending Part, apply in relation to an application under subsection
23-15(1)
of the Act that is received by a private health insurer on or after the commencement time.
(2)
Sections
23-16
and
23-20
of the Act, as inserted or amended by the amending Part, apply in relation to an application under subsection
23-15(1)
of the Act that is notified to the Chief Executive Medicare before the commencement time if the application has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.
(3)
Section
23-30
of the Act, as amended by the amending Part, applies in relation to a notice under subsection
23-30(1)
of the Act that is given to a private health insurer on or after the commencement time.
27 Participants in the premiums reduction scheme
(1)
A person who was a participant in the premiums reduction scheme immediately before the commencement time continues to be a participant after that time as if the person had been registered under subsection
23-16(1)
of the Act as inserted by the amending Part.
(2)
The person
'
s registration, after the commencement time, may be dealt with under Division
23
of the Act as amended by the amending Part.
28 Application of amendments relating to claims for reimbursement
(1)
Section
279-10
of the Act, as repealed and substituted by the amending Part, applies in relation to a claim for reimbursement made on or after the commencement time.
(2)
Sections
279-11
and
279-15
of the Act, as inserted or amended by the amending Part, apply in relation to a claim for reimbursement made before the commencement time if the claim has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.
29 Pending applications for additional payments
(1)
This item applies in relation to an application made under subsection
279-25(2)
or
279-30(2)
of the Act if the application:
(a)
was made before the commencement time; and
(b)
has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.
(2)
The application is taken, at the commencement time, to have been a claim made in accordance with section
279-10
of the Act and may be dealt with under Division
279
of the Act as amended by the amending Part.
30 Reconsideration of decisions
(1)
This item applies in relation to a notice of a decision given to a private health insurer in accordance with subsection
279-20(2)
or
279-40(3)
of the Act if:
(a)
the notice was given before the commencement time; and
(b)
the period referred to in section
279-45
of the Act for making a request to the Chief Executive Medicare to reconsider the notified decision has not expired before the commencement time.
(2)
After the commencement time:
(a)
the notice is taken to be a notice given to the private health insurer in accordance with subsection
279-11(3)
of the Act, as inserted by the amending Part; and
(b)
the private health insurer may request the Chief Executive Medicare to reconsider the decision by the end of the same period as the period referred to in paragraph (1)(b) of this item.
31 Recovery of payments
31
Section
282-1
of the Act, as amended by the amending Part, applies in relation to an amount that is paid on or after the commencement time.
32 Validation of registration of persons as participants in the premiums reduction scheme
(1)
If:
(a)
before the commencement time a person was registered, or purportedly registered, under section
23-15
of the Act as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and
(b)
a computer program was used in relation to the registration, under section
23-15
of the Act, of the person in the premiums reduction scheme in a way that was not authorised by the Act;
(c)
the Act had authorised the responsible person to arrange for the use of computer programs to approve the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and
(d)
such arrangements had been in force; and
(e)
the responsible person had been satisfied that paragraphs
23-15(1)(a)
,
(b)
and
(c)
of the Act (as in force at the time the computer program was used in relation to the registration of the person) applied in relation to the person.
(2)
For the purposes of this item, the
responsible person
is:
(a)
before 1 July 2011
-
the Chief Executive Officer of Medicare Australia; or
(b)
on or after 1 July 2011
-
the Chief Executive Medicare.
33 Validation of refusals to register persons as participants in the premiums reduction scheme
(1)
If:
(a)
before the commencement time the responsible person refused, or purportedly refused, to register a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and
(b)
a computer program was used in relation to the refusal to register the person in a way that was not authorised by the Act;
(c)
the Act had authorised the responsible person to arrange for the use of computer programs to refuse the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and
(d)
such arrangements had been in force; and
(e)
the responsible person had not been satisfied that paragraphs 23-15(1)(a), (b) and (c) of the Act (as in force at the time the computer program was used in relation to the refusal to register the person) applied in relation to the person.
(2)
For the purposes of this item, the
responsible person
is:
(a)
before 1 July 2011
-
the Chief Executive Officer of Medicare Australia; or
(b)
on or after 1 July 2011
-
the Chief Executive Medicare.
34 Validation of revocations of persons
'
registration as participants in the premiums reduction scheme
(1)
If:
(a)
before the commencement time the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer was revoked under subsection
23-30(3)
of the Act; and
(b)
a computer program was used in relation to the revocation of the person
'
s registration in a way that was not authorised by the Act;
(c)
the Act had authorised the responsible person to arrange for the use of computer programs to revoke the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy; and
(d)
such arrangements had been in force.
(2)
For the purposes of this item, the
responsible person
is:
(a)
before 1 July 2011
-
the Chief Executive Officer of Medicare Australia; or
(b)
on or after 1 July 2011
-
the Chief Executive Medicare.
35 Transitional rules
(1)
The Minister may, by legislative instrument, make rules prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to:
(a)
the enactment of this Act; or
(b)
the amendments of regulations or any other instruments made under any Act, where those amendments are in connection with the enactment of this Act.
(2)
To avoid doubt, the rules may not do the following:
(a)
create an offence or civil penalty;
(b)
provide powers of:
(i)
arrest or detention; or
(ii)
entry, search or seizure;
(c)
impose a tax;
(d)
set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;
(e)
directly amend the text of this Act.
(3)
Items 26 to 31 of this Part do not limit the rules that may be made for the purposes of subitem (1) of this item.
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